Feasibility, acceptability, and predictive validity of a psychosocial screening program for children and youth newly diagnosed with type 1 diabetes
David D Schwartz, Virginia Depp Cline, Marni E Axelrad, Barbara J Anderson, David D Schwartz, Virginia Depp Cline, Marni E Axelrad, Barbara J Anderson
Abstract
Objective: Psychosocial screening has been recommended for pediatric patients with newly diagnosed type 1 diabetes and their families. Our objective was to assess a psychosocial screening protocol in its feasibility, acceptability to families, and ability to predict early emerging complications, nonadherent family behavior, and use of preventive psychology services.
Research design and methods: A total of 125 patients and their caregivers were asked to participate in a standardized screening interview after admission at a large urban children's hospital with a new diagnosis of type 1 diabetes. Medical records were reviewed for subsequent diabetes-related emergency department (ED) admissions, missed diabetes clinic appointments, and psychology follow-up within 9 months of diagnosis.
Results: Of 125 families, 121 (96.8%) agreed to participate in the screening, and a subsample of 30 surveyed caregivers indicated high levels of satisfaction. Risk factors at diagnosis predicted subsequent ED admissions with a sensitivity of 100% and a specificity of 98.6%. Children from single-parent households with a history of behavior problems were nearly six times more likely to be seen in the ED after diagnosis. Missed appointments were likeliest among African Americans, 65% of whom missed at least one diabetes-related appointment. Psychology services for preventive intervention were underutilized, despite the high acceptability of the psychosocial screening.
Conclusions: Psychosocial screening of newly diagnosed patients with type 1 diabetes is feasible, acceptable to families, and able to identify families at risk for early emerging complications and nonadherence. Challenges remain with regards to reimbursement and fostering follow-up for preventive care.
References
- Schwartz DD, Cline VD, Hansen JA, Axelrad ME, Anderson BJ. Early risk factors for nonadherence in pediatric type 1 diabetes: a review of the recent literature. Curr Diabetes Rev 2010;6:167–183
- Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA 2003;290:2159–2167
- Hood KK, Huestis S, Maher A, Butler D, Volkening L, Laffel LM. Depressive symptoms in children and adolescents with type 1 diabetes: association with diabetes-specific characteristics. Diabetes Care 2006;29:1389–1391
- Zuckerbrot RA, Maxon L, Pagar D, Davies M, Fisher PW, Shaffer D. Adolescent depression screening in primary care: feasibility and acceptability. Pediatrics 2007;119:101–108
- Cameron FJ, Northam EA, Ambler GR, Daneman D. Routine psychological screening in youth with type 1 diabetes and their parents: a notion whose time has come? Diabetes Care 2007;30:2716–2724
- Pihoker C, Forsander G, Wolfsdorf J, Klingensmith GJ. The delivery of ambulatory diabetes care: structures, processes, and outcomes of ambulatory diabetes care. Pediatr Diabetes 2008;9:609–620
- Silverstein J, Klingensmith G, Copeland K, et al. American Diabetes Association Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 2005;28:186–212
- Kazak A. Pediatric Psychosocial Preventative Health Model (PPPHM): research, practice and collaboration in pediatric family systems medicine. Fam Syst Health 2006;24:381–395
- Varni JW, Burwinkle TM, Lane MM. Health-related quality of life measurement in pediatric clinical practice: an appraisal and precept for future research and application. Health Qual Life Outcomes 2005;3:34.
- Johnston O, Fornai G, Cabrini S, Kendrick T. Feasibility and acceptability of screening for eating disorders in primary care. Fam Pract 2007;24:511–517
- Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med 2008;358:661–663
- Kazak A, Prusak A, McSherry M, et al. The Psychosocial Assessment Tool (PAT): pilot data on a brief screening instrument for identifying high risk families in pediatric oncology. Fam Syst Health 2001;19:303–317
- Schwartz D, Anderson B. An evidence-based program for early identification of risk factors in children and adolescents with type 1 diabetes and their families. Poster presented at the 2008 National Conference in Child Health Psychology, 11 April 2008, Miami, FL
- Kazak AE, Cant MC, Jensen MM, et al. Identifying psychosocial risk indicative of subsequent resource use in families of newly diagnosed pediatric oncology patients. J Clin Oncol 2003;21:3220–3225
- Noll RB, Fischer S. Commentary. Health and behavior CPT codes: an opportunity to revolutionize reimbursement in pediatric psychology. J Pediatr Psychol 2004;29:571–578
- Maldonado MR, Chong ER, Oehl MA, Balasubramanyam A. Economic impact of diabetic ketoacidosis in a multiethnic indigent population: analysis of costs based on the precipitating cause. Diabetes Care 2003;26:1265–1269
- Axelrad ME, Garland BH, Love KB. Brief behavioral intervention for young children with disruptive behaviors. J Clin Psychol Med Settings 2009;16:263–269
- Anderson B, Brackett J, Ho J, Laffel L. An intervention to promote family teamwork in diabetes management tasks: relationships among parental involvement, adherence to blood glucose monitoring, and glycemic control in young adolescents with type 1 diabetes. In Promoting Adherence to Medical Treatment in Chronic Childhood Illness: Concepts, Methods, and Interventions. Drotar D, Ed. Upper Saddle River, NJ, Lawrence Erlbaum, 2000, p. 347–366
- Kaufman FR, Halvorson M, Carpenter S. Association between diabetes control and visits to a multidisciplinary pediatric diabetes clinic. Pediatrics 1999;103:948–951
- Elster A, Jarosik J, VanGeest J, Fleming M. Racial and ethnic disparities in health care for adolescents: a systematic review of the literature. Arch Pediatr Adolesc Med 2003;157:867–874
- Kahana S, Drotar D, Frazier T. Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions. J Pediatr Psychol 2008;33:590–611
- Rodrigue J, Hoffman R, Rayfield A, et al. Evaluating pediatric psychology consultation services in a medical setting: an example. J Clin Psychol Med Settings 1995;2:89–107
- Laffel LM, Brackett J, Ho J, Anderson BJ. Changing the process of diabetes care improves metabolic outcomes and reduces hospitalizations. Qual Manag Health Care 1998;6:53–62
- Svoren BM, Butler D, Levine BS, Anderson BJ, Laffel LM. Reducing acute adverse outcomes in youths with type 1 diabetes: a randomized, controlled trial. Pediatrics 2003;112:914–922
- McHorney CA, Earl Bricker D., Jr A qualitative study of patients’ and physicians’ views about practice-based functional health assessment. Med Care 2002;40:1113–1125
Source: PubMed